Overview
Mallory-Weiss tears involve longitudinal mucosal lacerations at the gastroesophageal junction, often precipitated by forceful vomiting or retching but can occur post-procedurally, such as after transoesophageal echocardiography 1.Diagnosis
Clinical Presentation: Acute, often massive, upper gastrointestinal bleeding 1.
Diagnostic Tests: Endoscopy is definitive, showing characteristic mucosal tears 1.
Grading: Typically not graded but severity assessed by bleeding volume and hemodynamic stability 1.Management
First-Line Treatment: Intravenous fluid resuscitation and blood transfusion as needed 1.
Endoscopic Intervention: Hemostatic therapy (e.g., epinephrine injection, clips) for actively bleeding tears 1.
Prokinetic Agents: May be considered to promote gastric emptying and reduce aspiration risk 1.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Avoid to prevent further mucosal irritation 1.Special Populations
Postoperative Patients: Caution advised with esophageal instrumentation post-transoesophageal echocardiography to prevent tears 1.Key Recommendations
Exercise caution with esophageal instrumentation, including nasogastric tube insertion, following transoesophageal echocardiography to minimize Mallory-Weiss tear risk (Evidence: Expert opinion) 1.
Prompt endoscopic evaluation is crucial for diagnosis and management of bleeding Mallory-Weiss tears (Evidence: Moderate) 1.
Hemodynamic stabilization through fluid resuscitation and blood transfusion should be prioritized in acute bleeding scenarios (Evidence: Moderate) 1.References
1 De Vries AJ, van der Maaten JM, Laurens RR. Mallory-Weiss tear following cardiac surgery: transoesophageal echoprobe or nasogastric tube?. British journal of anaesthesia 2000. link